Anesthesia-handover Checklist and Perioperative Outcomes in Elderly

It was estimated that more than 9 million patients undergo surgery with a complete anesthesia handover each year worldwide. Verbal handover from one anesthesiologist to another during surgery are being used in many hospitals; and there is no unified patient handover guideline at present.

It is well recognized that the transfer-of-care is a point of vulnerability where valuable patient information can be distorted and omitted. A previous study of the investigators showed that handover of anesthesia care was associated with a higher risk of delirium in elderly patients after major noncardiac surgery. The World Health Organization has included communication during patient care handovers among its top 5 patient safety initiatives.

It is possible that an improved anesthesia-handover protocol may reduce the related adverse events. Many efforts have performed to optimize handover processes. However, handover quality between anesthesiologists has rarely been investigated. The investigators hypothesize that a well-designed, structured handover-checklist will improve handover quality and reduce the occurrence of postoperative complications.

Inclusion criteria

• Elderly patients (aged 65 years and over);
• Scheduled to undergo major non-cardiac surgery with an expected duration of at least 2 hours;
• Requirement of complete handover between anesthesiologists during surgery (initial anesthesiologist no longer returns).

Exclusion criteria

• Preoperative history of schizophrenia, epilepsy, Parkinsonism or myasthenia gravis;
• Inability to communicate before surgery (coma, profound dementia or language barrier);
• Craniocerebral injury or neurosurgery;
• Severe liver dysfunction (Child-Pugh grade C), severe renal dysfunction (requiring dialysis), or expected survival of <24 hours.